County officials warn of more HIV among homeless drug users

A group of eight recently homeless and heterosexual injection-drug users in North King County were diagnosed with HIV by county health officials over the past year, prompting concerns that HIV transmission among that population may be on the rise.

In total, 19 heterosexual individuals have been diagnosed with HIV in King County over the past year, up from seven last year. On average, 10 heterosexual individuals are diagnosed with HIV every year, according to health officials.

What makes the spike especially significant, according to Jeff Duchin, health officer at King County Public Health, is that it’s occurring among a demographic that hasn’t traditionally experienced high rates of HIV infection: heterosexual injection-drug users. Historically, gay and bisexual men have been most at risk of contracting HIV, both in King County and across the state. Similarly, local gay and bisexual injection-drug users—specifically those who use methamphetamine, a stimulant—experienced higher HIV infection rates. However, given that injection-drug users across the county are increasingly using both opioids (such as heroin) and methamphetamine, health officials are concerned that more heterosexual drug users may be contracting HIV. “If HIV begins to spread in a new population of persons who inject drugs who don’t have other risk factors for HIV, there can be a large outbreak, potentially,” Duchin said at a Aug. 30 press conference. “All of our recently identified cases have used both opioids and methamphetamine.”

Additionally, many injection-drug users in the county are homeless, Duchin said, potentially increasing the risk of needle-sharing. Of the eight individuals in North King County recently diagnosed with HIV who were heterosexual and recently homeless, some of them traded sex for drugs or money, and health officials have identified transmission links among four of them, Duchin said.

The eight individuals—whom Duchin described as a “cluster”—were identified through the county’s HIV monitoring program. When a patient tests positive for HIV, medical providers and laboratories are required to notify health officials, who then try to connect the patient to services and treatment. While some individuals who contracted HIV this year were identified through this system, others were identified only after additional investigation by public authorities, adding to the concern that there may be more unreported cases among a population without frequent access to medical services or who may struggle to stay on HIV-treatment drugs. (HIV is treatable with drugs dubbed antiretrovirals, which, if taken according to a regular regimen, can significantly reduce a patient’s viral load.)

“Homelessness and injection-drug use go hand-in-hand in our community, and homeless people have poor access to medical care,” Duchin said. “If they have HIV infections, sometimes it’s more difficult for them to comply with their treatment, and therefore they may have a higher viral load and be more likely to transmit.”

Duchin said that while there is cause for concern, more data is needed to draw substantive conclusions: “We need to do more testing and try and find out if this is the tip of the iceberg or if this is a small, limited transmission event that we’ve discovered,” he said. “If this problem is more extensive than we know or it continues to grow, it could present a very large challenge to our HIV-control program and to our community.” He said that public-health officials are increasing outreach among homeless or recently homeless injection-drug users to test them, connect them to treatment, and distribute sterile syringes.